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The digital revolution is disrupting the ways in which health research is conducted, and subsequently, changing healthcare. Direct-to-consumer wellness products and mobile apps, pervasive sensor technologies and access to social network data offer exciting opportunities for researchers to passively observe and/or track patients ‘in the wild’ and 24/7. The volume of granular personal health data gathered using these technologies is unprecedented, and is increasingly leveraged to inform personalized health promotion and disease treatment interventions. The use of artificial intelligence in the health sector is also increasing. Although rich with potential, the digital health ecosystem presents new ethical challenges for those making decisions about the selection, testing, implementation and evaluation of technologies for use in healthcare. As the ‘Wild West’ of digital health research unfolds, it is important to recognize who is involved, and identify how each party can and should take responsibility to advance the ethical practices of this work. While not a comprehensive review, we describe the landscape, identify gaps to be addressed, and offer recommendations as to how stakeholders can and should take responsibility to advance socially responsible digital health research.

A central goal of behavioral medicine is the creation of evidence-based interventions for promoting behavior change. Scientific knowledge about behavior change could be more effectively accumulated using “ontologies.” In information science, an ontology is a systematic method for articulating a “controlled vocabulary” of agreed-upon terms and their inter-relationships. It involves three core elements: (1) a controlled vocabulary specifying and defining existing classes; (2) specification of the inter-relationships between classes; and (3) codification in a computer-readable format to enable knowledge generation, organization, reuse, integration, and analysis. This paper introduces ontologies, provides a review of current efforts to create ontologies related to behavior change interventions and suggests future work. This paper was written by behavioral medicine and information science experts and was developed in partnership between the Society of Behavioral Medicine’s Technology Special Interest Group (SIG) and the Theories and Techniques of Behavior Change Interventions SIG. In recent years significant progress has been made in the foundational work needed to develop ontologies of behavior change. Ontologies of behavior change could facilitate a transformation of behavioral science from a field in which data from different experiments are siloed into one in which data across experiments could be compared and/or integrated. This could facilitate new approaches to hypothesis generation and knowledge discovery in behavioral science.

Other fast lanes, while forming below the cell surface, push released particles to “surf” towards noninfected cells [7]. [...]some viruses take advantage of structures built by circulating cells to communicate, such as the immunological synapse, to spread more rapidly [2]. [...]the lowest portion of the tract that lacks cilia and mucus is safeguarded by macrophages that destroy particles. [...]mechanisms that allow viral spread within the airway epithelia without particle release would be highly advantageous, and recent studies suggest that some respiratory viruses have indeed developed alternative means of spread. [...]the complete assembly of virions is not needed, and direct cell-to-cell transfer of viral genetic material, proteins, nucleocapsids, or replication bodies is most likely occurring. [...]disruption of intercellular extensions or intercellular pores by different means leads to reduced and/or less efficient viral spread.

Autism is a normal part of cognitive diversity, resulting in communication and sensory processing differences, which can become disabling in a neurotypical world. Autistic people have an increased likelihood of physical and mental co-occurring conditions and die earlier than neurotypical peers. Inaccessible healthcare may contribute to this. Autism Health Passports (AHPs) are paper-based or digital tools which can be used to describe healthcare accessibility needs; they are recommended in UK clinical guidance. However, questions remained as to the theoretical underpinnings and effectiveness of AHPs. We undertook a systematic literature search identifying studies focused on AHPs for adults (aged over 16 years) from five databases. Included literature was subjected to realist evaluation. Data were extracted using a standardised form, developed by the research team, which considered research design, study quality for realist review and the Context, Mechanisms and Outcomes (CMOs) associated with each AHP tool. 162 unique records were identified, and 13 items were included in the review. Only one item was considered high quality. Contextual factors focused on the inaccessibility of healthcare to Autistic patients and staff lack of confidence and training in supporting Autistic needs. Interventions were heterogeneous, with most sources reporting few details as to how they had been developed. The most frequently included contents were communication preferences. Mechanisms were often not stated or were inferred by the reviewers and lacked specificity. Outcomes were included in four studies and were primarily focused on AHP uptake, rather than Outcomes which measured impact. There is insufficient evidence to conclude that AHPs reduce the health inequalities experienced by Autistic people. Using an AHP tool alone in a healthcare Context that does not meet Autistic needs, without the inclusion of the local Autistic community developing the tool, and a wider intervention to reduce known barriers to health inequality, may mean that AHPs do not trigger any Mechanisms, and thus cannot affect Outcomes.

Initiation of host cell infection by an enveloped virus requires a viral-to-host cell membrane fusion event. This event is mediated by at least one viral transmembrane glycoprotein, termed the fusion protein, which is a key therapeutic target. Viral fusion proteins have been studied for decades, and numerous critical insights into their function have been elucidated. However, the transmembrane region remains one of the most poorly understood facets of these proteins. In the past ten years, the field has made significant advances in understanding the role of the membrane-spanning region of viral fusion proteins. We summarize developments made in the past decade that have contributed to the understanding of the transmembrane region of viral fusion proteins, highlighting not only their critical role in the membrane fusion process, but further demonstrating their involvement in several aspects of the viral lifecycle.

Smokers are a stigmatized population, but an important population to reach for the purpose of research. Therefore, innovative recruitment methods are needed that are both cost-effective and efficacious in recruiting this population. The aim of the present article was to evaluate the feasibility of Facebook-targeted advertisement to recruit long-term smokers eligible for lung cancer screening for a descriptive, cross-sectional survey. A social media recruitment campaign was launched using Facebook-targeted advertisement to target age and keywords related to tobacco smoking in the Facebook users profile, interests, and likes. A 3-day newspaper advertisement recruitment campaign was used as a comparison. The study that used both recruitment methods aimed to test the psychometric properties of 4 newly developed lung cancer screening health belief scales. Data were collected via cross-sectional survey methodology using an Web-based survey platform. The Facebook-targeted advertisements were viewed 56,621 times over an 18-day campaign in 2015 in the United States. The advertisement campaign yielded 1121 unique clicks to the Web-based survey platform at a cost of $1.51 per completed survey. Of those who clicked through to the study survey platform, 423 (37.7%) consented to participate; 92 (8.2%) dropped out during completion of the survey yielding a final study pool of 331 completed surveys. Recruitment by newspaper advertisement yielded a total of 30 participants in response to a 3-day advertisement campaign; recruitment efficacy resulted in 10 participants/day at $40.80 per completed survey. Participants represented current (n=182; 51%) and former smokers (n=178; 49%) with a mean age of 63.4 years (SD 6.0). Cost of the advertisement campaign was $500 total for the 18-day campaign. Recruitment by Facebook was more efficacious and cost-effective compared with newspaper advertisement. Facebook offers a new venue for recruitment into research studies that offer the potential for wider reach at a lower cost while providing privacy and flexibility for potential study participants. The study's findings extend recent work of other researchers who have demonstrated Facebook's utility with younger smokers, and Facebook is an effective tool to recruit older smokers. Furthermore, Facebook is a cost-effective alternative to traditional newspaper advertisement offering a new, affordable venue to recruit large numbers of older smokers efficiently.

Researchers use digital technologies to collect health behavior data. These tools are publicly available and under-regulated. An iterative process involving experts informed a checklist tool to aid in responsible selection of technologies for use in health research. Abstract Digital technologies offer researchers new approaches to test personalized and adaptive health interventions tailored to an individual. Yet, research leveraging technologies to capture personal health data involve technical and ethical consideration during the study design phase. No guidance exists to facilitate responsible digital technology selection for research purposes. A stakeholder-engaged and iterative approach was used to develop, test, and refine a checklist designed to aid researchers in selecting technologies for their research. First, stakeholders (n = 7) discussed and informed key decision-making domains to guide app/device selection derived from the American Psychiatric Association’s framework that included safety, evidence, usability, and interoperability. We added “ethical principles” to the APA’s hierarchical model and created a checklist that was used by a small group of behavioral scientists (n = 7). Findings revealed the “ethical principles” domains of respect, beneficence, and justice cut across each decision-making domains and the checklist questions/prompts were revised accordingly and can be found at thecore.ucsd.edu. The refined checklist contains four decision-making domains with prompts/questions and ethical principles embedded within the domains of privacy, risk/benefit, data management, and access/evidence. This checklist is the first step in leading the narrative of decision-making when selecting digital health technologies for research. Given the dynamic and rapidly evolving nature of digital health technology use in research, this tool will need to be further evaluated for usefulness in technology selection.

Poor medication adherence is a significant problem, yet interventions to improve it have been largely ineffective. Existing ecological models indicate that adherence is multi-dimensional; however, they do not reflect understanding of context-specific processes and how they lead to adherence outcomes. A framework that reflects context-specific processes is important because it could be used to inform context-specific intervention delivery and measure associated adherence outcomes. The purpose of this paper is to describe the Medication Adherence Context and Outcomes (MACO) framework, which includes contexts (ie, clinics, pharmacies, and home) and context-specific processes (ie, shared decision-making, prescription filling strategies, home medication management) that lead to adherence outcomes (initiation, implementation, discontinuation, and persistence). The Medication and Adherence Contexts and Outcomes (MACO) framework was iteratively developed between 2015 and 2018 based on theory, practice, and research and combining patient experience journey mapping to chronologically describe the environmental contexts and actions (processes) that occur within the contexts and how they contribute to medication adherence as outcome. The three distinct yet interrelated contexts described in the MACO framework are 1) clinical encounters, 2) pharmacy encounters, and 3) day-to-day home management. Within these contexts are specific medication management actions that occur (processes) in order to produce adherence-related outcomes (initiation, implementation, and discontinuation/persistence). The MACO framework distinguishes context-specific processes and outcomes. The MACO framework may be useful to understand at which point(s) along the continuum people experience problems with managing medications. This understanding is potentially useful for developing and delivering context-specific interventions that are based on processes that underlie nonadherence and selecting adherence measures appropriate for the contexts.

Before the COVID-19 pandemic and the disruptions it brought, medication adherence was already a challenging and complex health behavior. The purpose of this study was to describe patients' interactions in clinic, pharmacy, and home contexts and associated medication management and adherence during the early phase of the COVID-19 pandemic. A survey questionnaire was developed using the Medication Adherence Context and Outcomes framework and distributed via social media between May and July 2020 targeting adults taking a daily prescribed medication. Survey questions assessed sociodemographics, interactions with healthcare providers, clinics, pharmacies, medication management experiences, habit strength, and life chaos perceptions during the pandemic. Medication adherence was assessed by the self-report BAASIS© scale to measure implementation, discontinuation, and overall nonadherence. A total of 134 adults from the United States, mean age 50.0 (SD 16.1) years were included in this analysis. Respondents took a median of 3.50 (interquartile range 4) daily medications. Delays in seeing a provider were reported by 47 (35.1%). Pharmacy encounters were impacted; 25 (18.7%) indicated their method for obtaining medication changed. Medication nonadherence was reported among 62 (46.3%) and was significantly greater among those who delayed prescription refills (p=0.032), pillbox users (p=0.047), and those who experienced greater life chaos (p=0.040) and lower habit strength (p<0.001) in the early phase of the pandemic. Although the early phase of the pandemic affected access to care for nearly one-third of the sample, distance-accessible care options and strategies to obtain needed services without being in-person supported respondents medication management. Helpful strategies included provider accessibility, telehealth, home delivery/mail-order, drive-thru's, 90-day supplies, and online/automatic refills. Methods to develop and reestablish habits are critical. Care providers in clinic and pharmacy settings can educate and remind patients about services like distance-accessible technologies and online ordering of medications and establishing routines to support medication adherence.